Prospective study of 116 tibial diaphyseal fractures with continuous 24-hour anterior compartment pressure monitoring. The study tests whether differential pressure (diastolic BP minus compartment pressure) outperforms absolute pressure thresholds for diagnosing acute compartment syndrome and guiding fasciotomy.
Before this paper, the standard teaching was to perform fasciotomy when absolute compartment pressure exceeded 30 mmHg. That threshold ignores the patient's blood pressure entirely — a number that determines whether that tissue pressure is actually ischemic.
When you are monitoring a tibial fracture, use differential pressure (diastolic BP minus compartment pressure) and act when it drops below 30 mmHg. A compartment pressure of 55 mmHg in a patient with diastolic BP 90 mmHg requires only observation. The same pressure in a hypotensive trauma patient is an emergency.
Do not be falsely reassured by an open fracture wound. This paper showed no difference in compartment pressures between open and closed tibial fractures. Open wounds do not reliably decompress the compartment, and ACS after open tibial fracture is a real entity.
Continuous monitoring matters because two of three ACS cases in this series had lag periods of 18 to 24 hours before pressures reached critical levels. A single intraoperative measurement would have been falsely reassuring in both.
Prospective study of 116 tibial diaphyseal fractures with continuous 24-hour anterior compartment pressure monitoring. The study tests whether differential pressure (diastolic BP minus compartment pressure) outperforms absolute pressure thresholds for diagnosing acute compartment syndrome and guiding fasciotomy.
Before this paper, the standard teaching was to perform fasciotomy when absolute compartment pressure exceeded 30 mmHg. That threshold ignores the patient's blood pressure entirely — a number that determines whether that tissue pressure is actually ischemic.
When you are monitoring a tibial fracture, use differential pressure (diastolic BP minus compartment pressure) and act when it drops below 30 mmHg. A compartment pressure of 55 mmHg in a patient with diastolic BP 90 mmHg requires only observation. The same pressure in a hypotensive trauma patient is an emergency.
Do not be falsely reassured by an open fracture wound. This paper showed no difference in compartment pressures between open and closed tibial fractures. Open wounds do not reliably decompress the compartment, and ACS after open tibial fracture is a real entity.
Continuous monitoring matters because two of three ACS cases in this series had lag periods of 18 to 24 hours before pressures reached critical levels. A single intraoperative measurement would have been falsely reassuring in both.